Arterial stiffness is highly correlated with the scores obtained from the Steno Type 1 Risk Engine in subjects with T1DM

Abstract

Steno Type 1 Risk Engine (ST1RE); Arterial stiffness; Type 1 diabetes (T1DM)

Motor de Risc Steno Tipus 1; Rigidesa arterial; Diabetis mellitus tipus 1 (DM1)

Motor de Riesgo Steno Tipo 1; Rigidez arterial; Diabetes mellitus tipo 1 (DM1)

OBJECTIVES: Currently used risk scores for type 2 diabetes mellitus (T2DM) clearly underestimate cardiovascular risk in type 1 diabetes (T1DM). Hence, there is a need to develop novel and specific risk-estimation tools for this population. We aimed to assess the relationship between the Steno Type 1 Risk Engine (ST1RE) and arterial stiffness (AS), and to identify potential cut-off points of interest in clinical practice.

DESIGN AND METHODS: A total of 179 patients with T1DM (50.8% men, mean age 41.2±13.1 years), without established cardiovascular disease, were evaluated for clinical and anthropometric data (including classical cardiovascular risk factors), and AS measured by aortic pulse-wave velocity (aPWV). The ST1RE was used to estimate 10-year cardiovascular risk and patients were classified into 3 groups: low- (<10%; n = 105), moderate- (10-20%; n = 53) and high-risk (≥20%; n = 21).

RESULTS: When compared with the low- and moderate-risk groups, patients in the high-risk group were older, had higher prevalence of hypertension, dyslipidemia and insulin-resistance, and had higher body-mass index and HbA1c. aPWV increased in parallel with estimated cardiovascular risk (6.4±1.0, 8.4±1.3 and 10.3±2.6m/s; p<0.001). As an evaluation of model performance, the C-statistic of aPWV was 0.914 (95% confidence interval [CI]:0.873-0.950) for predicting moderate/high-risk and 0.879 (95%CI:0.809-0.948) for high-risk, according to the ST1RE. The best cut-off points of aPWV were 7.3m/s (sensitivity:86%, specificity:83%) and 8.7m/s (sensitivity:76%, specificity:86%) for moderate/high- and high-risk, respectively.

CONCLUSIONS: AS is highly correlated with the scores obtained from the ST1RE. We have identified two cut-off points of AS that can clearly discriminate moderate/high- and high-risk T1DM patients, which could be of great value in clinical practice.

Financial support was provided through the Fondo de Investigacion Sanitaria (FIS) PI09/01360 (PI: JMCG), PI12/00954 (PI: JMCG) and PI15/00567 (PI: JMCG) as part of the National R+D+I (2008-2011) and was co-financed by the Instituto de Salud Carlos III - General Evaluation Branch (Spanish Ministry of Economy and Competitiveness) and the European Regional Development Fund (ERDF). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.